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Doctors at SL Raheja Hospital, Mahim treat a rare life-threatening breast infection in a 48yr old Mumbaikar

Doctors at SL Raheja Hospital, Mahim – A Fortis Associate treated a young woman with a rare and life-threatening bacterial infection - ‘Necrotizing Fasciitis (also called a flesh-eating disease) of the breast, associated with Sterna Osteomyelitis. Patient was medically stabilized by Dr. Paritosh Baghel, Consultant General Physician & Dr. Sanjith Saseedharan, Consultant & Head-Critical Care and their teams, while the surgery and following treatment were successfully done by Dr. Leena Jain, Consultant Plastic & Reconstructive Microsurgeon, and her team comprising of Dr. Samir Kumta, Consultant Plastic Surgeon, Dr. Rajeev Wadhwa, Consultant General Physician, Dr. Sushil Nehete, Consultant Plastic Surgeon and Dr. Kamlesh Shaha, Consultant Cardiovascular Thoracic Surgery.

The woman was suffering from Necrotizing Fasciitis of the breast without any prior history of trauma or breast surgery or breastfeeding. This is an extremely rare condition with less than a handful of reported cases. This kind of breast infection causing infection of the Sternum (midline chest bone) has not been reported much so far.

The patient first noticed a painful swelling in her left breast, in the latter half of April 2021. She was running high-grade fever and was incidentally found to be a diabetic with high sugar levels. She was operated on May 1, 2021, to drain the abscess, but the infection persisted and extended to involve the chest wall skin & bones. She was then brought to SL Raheja Hospital, Mahim with a working diagnosis of Necrotizing Fasciitis of the breast and the chest wall. CT of the chest revealed Osteomyelitis (bacterial or fungal infection of the bone) of the Sternum and adjacent ribs. In fact, Sternal Osteomyelitis following a breast abscess is unheard of. Sternal Osteomyelitis is an infection of the midline chest bone. Infection here can lead to lung infection or can even involve the lining of the heart, which is a dangerous situation. Osteomyelitis requires a multimodal treatment strategy - surgery and long-term antibiotic injections.

“When the patient was brought to our hospital, she had lost significant weight and her sugars were still high. This was also a case of undetected and uncontrolled Diabetes. In this case, uncontrolled Diabetes paved the path for the spread of infection. So, the first thing that we had to do is control her sugar levels, after which a debridement surgery was done to remove all non-viable tissues - six costal cartilages on each side were removed, along with slough and unhealthy collections were cleared. The cartilages broke like chalk pieces. However, the breastbone seemed clinically healthy. Cultures from the wound showed Klebsiella (a type of Gram-negative bacteria that is known to cause notorious infections, including Pneumonia). A large wound of 18 x 12cms remained in the middle of the chest wall with Underlying lining of the lungs and heart covered with a flimsy layer of tissue. The wound was then covered with a flap taken from her back, and it healed uneventfully. All the surgical procedures were well managed by Dr. Pravin Lovhale, Consultant Anaesthesiologist. She will now need about 6 weeks of antibiotic injections to ensure complete eradication of the bone infection,” explained Dr Leena Jain.

“We are extremely grateful to the doctors & nurses at SL Raheja Hospital who have given a new lease of life to my wife. There was a misdiagnosis of her condition at the hospital she was previously admitted at. Prompt action taken by the doctors here have not only saved my wife’s life, but also ensured that she is healed of this condition”, said Fredrick Rebeiro (the patient’s husband)

“I am proud of clinicians and nursing teams who have deep-rooted values of patient centricity, integrity, and commitment, and that’s what makes them take up challenging cases & successfully resolve them”, says, Dr Kunal Punamiya-CEO, SL Raheja Hospital, Mahim – A Fortis Associate.

The complexity in this case involved removal of all devitalized tissues, like bones, in the vicinity of vital organs of the body and then reconstruction to cover with healthy & sturdy tissue to provide a protective cover. The patient has now been discharged and has been recovering at home.

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